Thoughts on monocular PAL wearers

**Jedi** · 06-27-2006, 11:56 AM

I'm wondering if I can get some input on various practices on dispensing progressives to a monocular patient. My aunt who has worn contacts all her life, had her eye examined recently and her doctor recommended progressives. I'm of the opinion that this is a bad idea, or one that will need much thought. The reason being she is a balance in one eye and her good eye is approx. -13.75 with a little bit of cyl. +2.00 add. My initial thought was the Ipseo, but that was short lived after recalling the lenses parameters. Any feedback for those of you who have actually dealt with this type of scenario would be appreciated, I am willing to entertain any thoughts, but keep in mind I still believe that CL's with readers is going to be the best overall solution.

**Happylady** · 06-27-2006, 12:26 PM

Another option is contacts with progressives over them. The distance would be whatever over refraction is needed. This way she doesn't have to take them on and off all the time. She won't be forever hunting her reading glasses. She will be able to look up and see clearly and look down and see clearly.

A separate pair of just reading glasses could also be used for the times she is doing nothing but sitting and reading if she feels a large reading area is needed.

**Ory** · 06-27-2006, 01:10 PM

Originally Posted by Jedi

I'm wondering if I can get some input on various practices on dispensing progressives to a monocular patient. My aunt who has worn contacts all her life, had her eye examined recently and her doctor recommended progressives. I'm of the opinion that this is a bad idea, or one that will need much thought. The reason being she is a balance in one eye and her good eye is approx. -13.75 with a little bit of cyl. +2.00 add. My initial thought was the Ipseo, but that was short lived after recalling the lenses parameters. Any feedback for those of you who have actually dealt with this type of scenario would be appreciated, I am willing to entertain any thoughts, but keep in mind I still believe that CL's with readers is going to be the best overall solution.

I'm not sure if this thread is titled correctly. Are you more concerned with the high myopia as your CL comment implies or the fact that she is monocular?

I have no problems with a progressive on a monocular patient. As a bonus, the balance lens can be single vision. I haven't seen anyone who is monocular have issues with a progressive.

A high myope will obviously get a great benefit out of contacts as the minification will not be an issue, but any CL wearer should have a backup pair of glasses. Especially with her prescription, if she was in a situation where she couldn't wear contacts it would become a huge issue. Keep in mind that excessive CL wear increases your risk of complications and you'll see that CLs constantly are perhaps not the best choice for her eye health. Having an alternative is necessary.

If she's happy with SV distance glasses then no big deal but if she wants to be able to read why not give her a progressive?

**For-Life** · 06-27-2006, 01:19 PM

Originally Posted by Jedi

I'm wondering if I can get some input on various practices on dispensing progressives to a monocular patient. My aunt who has worn contacts all her life, had her eye examined recently and her doctor recommended progressives. I'm of the opinion that this is a bad idea, or one that will need much thought. The reason being she is a balance in one eye and her good eye is approx. -13.75 with a little bit of cyl. +2.00 add. My initial thought was the Ipseo, but that was short lived after recalling the lenses parameters. Any feedback for those of you who have actually dealt with this type of scenario would be appreciated, I am willing to entertain any thoughts, but keep in mind I still believe that CL's with readers is going to be the best overall solution.

What about the i and the Panamic in 1.74. Or try the Hoya ECP in the 1.7

**Jedi** · 06-27-2006, 03:19 PM

Originally Posted by Ory

I'm not sure if this thread is titled correctly. Are you more concerned with the high myopia as your CL comment implies or the fact that she is monocular?

Actually both. My big issue with my aunts high myopia is it does limit the choice of progressive especially in regards to the clarity of distance peripheral vision. I should clarify this, her right eye is "good", but this poses a concern as the left side is a large blind spot. She has had her share of vehicular mishaps, I don't want to contribute to more. Maybe I'm just over-thinking the whole situation, but like I mentioned before, it just seems like bad advice to begin with from her Dr.

**Ory** · 06-27-2006, 05:06 PM

Originally Posted by Jedi

Actually both. My big issue with my aunts high myopia is it does limit the choice of progressive especially in regards to the clarity of distance peripheral vision. I should clarify this, her right eye is "good", but this poses a concern as the left side is a large blind spot. She has had her share of vehicular mishaps, I don't want to contribute to more. Maybe I'm just over-thinking the whole situation, but like I mentioned before, it just seems like bad advice to begin with from her Dr.

Most monocular patients will tell you that they have little problem with driving. Perhaps they have to turn their head a little more to see the mirror or do a shoulder check. I highly doubt that putting her in a progressive will make this worse. The peripheral distortion is not likely much of an issue but it depends on if she's an eye mover or a head mover. She's likely already a head mover, at least in the car.

I do agree with you that there is little choice in that level of myopia. I've found the Zeiss Individual works well for high myopes

Has her doctor told her not to wear contacts for some reason? If not I think you'll find she will still wear the CLs mainly and the progressives rarely. As I've said already though, she really shouldn't be without some spectacle solution.

**Dave Nelson** · 06-27-2006, 05:49 PM

We have had problems in the past with monocular progressive wearers, since the corridors are set for binocular convergence, and the stimulus to converge is absent. The monocular may not "track" the corridor as well as a binocular person, and may have to compensate with head movements. Admittedly its not a huge problem, but you can give it some consideration if you do run into difficulties with the monocular progressive wearer.

**chip anderson** · 06-27-2006, 08:16 PM

Of course there are Bifocal Contacts and then you can make up a pair of lined bifocals for reading at night, watching television and finding the contacts. And yes they can be done in -13.00 or more.

Chip

**Jedi** · 06-27-2006, 11:22 PM

Thanks Chip, she has already gone done that road, couldn't find a happy medium in soft and doesn't want to go back to rigid lenses.

**eyekan** · 07-08-2006, 01:38 PM

She may not like the idea of RGPs, but that would probably be the choice that would give her the best visual quality. RGP technology has come a long way and are MUCH more comfortable than they used to be. Fitting any monocular patient in contacts should be done very cautiously, since there is a greater risk of vision loss due to CL wear. A high Oxygen RGP material would minimize this risk but not eliminate it. I may even try a multifocal RGP which give much better vision than soft bifocal CL (which pretty much suck in monocular patients).